Through a new acquisition, Amino Health will become Capital Rx’s patient-facing care navigation solution called Judi Care.

The post Capital Rx Expands Into Care Navigation with Acquisition of Amino Health appeared first on MedCity News.

Arkansas became the first state to pass a law banning pharmacy benefit managers from owning pharmacies, aiming to curb their market power and reduce drug costs. But major PBMs like CVS and Express Scripts are suing, claiming the law is unconstitutional.

The post Why CVS, Express Scripts Are Suing Over the Arkansas PBM Law appeared first on MedCity News.

President Trump’s plan to fix IVF might look bold in a headline. In reality, it doesn’t create a single new embryology lab. It doesn’t hire one more specialist. It won’t change the fact that right now, only people with plenty of money can afford IVF, and throwing subsidies at a market that’s already bottlenecked only shifts who pays.

The post Making Insurance Cover IVF Could Actually Reduce Access appeared first on MedCity News.

In partnership with Cost Plus Drugs and Waltz Health, Serve You Rx has added Stelara biosimilars Otulfi and Yesintek to its formulary.

The post Serve You Rx Adds 2 Stelara Biosimilars to Formulary to Help Patients Save Costs appeared first on MedCity News.

Amazon Pharmacy recently launched a new caregiver feature and expanded PillPack to Medicare Part D. The company says the updates will support medication adherence.

The post Amazon Pharmacy Brings PillPack to Medicare and Adds Caregiver Feature — Will It Make a Difference? appeared first on MedCity News.

Pear Suite recently won the payer/provider technology track of MedCity News’ INVEST Pitch Perfect contest. The startup provides a software platform for community health workers that helps them share data, submit claims and maintain compliance.

The post INVEST Pitch Perfect Spotlight: How Pear Suite Makes Sure Community Health Workers Get Paid appeared first on MedCity News.

UH Group replaces its CEO, the payer’s alleged nursing home practices, the future of pharmacy benefit managers, and the healthcare implications of the budget bill are part of the latest episode of the Debunked Podcast with MedCity News Editor-in-Chief Arundhati Parmar and Samir Batra, managing partner of Health Innovation Pitch.

The post Debunked Episode 16: Will Trump Administration’s Drug Pricing Policies Lead to the End of PBMs? appeared first on MedCity News.

[Sponsored] Provider data issues start at enrollment and continue throughout the provider lifecycle, impacting everything from credentialing to the provider directory. ProviderTrust’s new guide explores this topic.

The post Healthcare’s Provider Data Challenges appeared first on MedCity News.

Acquiring FarmboxRx will help Pyx Health tackle food insecurity, a challenge many of its members struggle with. 

The post Pyx Health Acquires FarmboxRx With $47.5M Funding Boost appeared first on MedCity News.

The combination of coverage awareness and care navigation powered by agentic AI has the potential to transform how older adults engage with the healthcare system.

The post The Age of Action: Seizing CMS’s Call to Reimagine Medicare appeared first on MedCity News.

UnitedHealth Group has had a difficult year marked by a dramatic stock drop, leadership shake-up and mounting regulatory scrutiny. Experts point to its aggressive Medicare Advantage strategy and a rapidly evolving healthcare landscape as key drivers of its challenges.

The post Analysis: The No Good, Very Bad Year for UnitedHealth appeared first on MedCity News.

What if the kind of cuts we should be talking about are the ones that actually make care better? Like cutting confusion. Because for many people, the biggest barrier to healthcare access isn’t cost or availability – it’s complexity.

The post A Call for Healthcare Cuts — But Not the Kind You’re Thinking Of appeared first on MedCity News.

This is a great opportunity to align your strategies with CMS’s evolving framework by refining care models to focus on impact, investing in digital capabilities that support data use, and continuing to build infrastructure that addresses disparities in care.

The post CMS’s Final Rule Impacting Star Ratings Puts Outcomes In Focus — Are Health Plans Ready to Take Action? appeared first on MedCity News.

May has seen a slew of executive hires, exits and layoffs across the healthcare industry. For example, the American Medical Association and TigerConnect named new CEOs, and Google and UnitedHealth Group have seen key executives leave their roles. There were also layoffs at organizations including Devoted Health and New York-Presbyterian.

The post Healthcare Moves: A Monthly Summary of Hires, Exits and Layoffs appeared first on MedCity News.

Priority Health has partnered with Virta Health to offer a suite of diabetes and weight management solutions to its employer clients.

The post Priority Health Teams Up with Virta Health for Diabetes, Weight Loss Support appeared first on MedCity News.

As speculation about whether Medicaid cuts will be part of the solution to our national debt problem continues, no one can predict how much the Medicaid rollback will be, or its impact on the one in five Americans who rely on it. 

The post When Medicaid Cost Cutting Is Simply Cost Shifting appeared first on MedCity News.

The current prior authorization process in U.S. healthcare constitutes a crisis, according to Jesse Ehrenfeld, immediate past president of the American Medical Association. Prior authorization is wasting clinicians’ time, delaying care and deepening public distrust — yet, payers show little urgency in fixing this problem, he said.

The post Why One Leader Is Calling Out Insurers’ Inaction on Prior Authorization appeared first on MedCity News.

Inaccurate provider data is creating a hidden crisis in healthcare by delaying care and driving up costs for both patients and health plans, according to CAQH CEO Sarah Ahmad. Her organization is working to address the issue by improving how provider data is collected and verified on the front end.

The post Bad Provider Data Is Delaying Care and Driving Up Costs, CAQH CEO Warns appeared first on MedCity News.

While prior authorization has made many headlines over the past year, concurrent review has not. Yet missteps in both processes leave hospitals in danger of not getting paid, which can result in higher costs being passed down to patients. 

The post What is Concurrent Review? appeared first on MedCity News.

As an industry, we can and must do more. To be truly actionable, prices must be easily accessible, understandable, and patients need to be actively engaged to act on that information.

The post Healthcare Price Transparency is More Than Showing a Price Tag appeared first on MedCity News.

GLP-1s have proven to be highly effective for weight loss but pose significant cost challenges for employers, according to a recent panel of experts at MedCity INVEST.

The post Are GLP-1s Worth the Hype? appeared first on MedCity News.

The tools exist today to significantly reduce PA’s burden on our healthcare system, we just need to mobilize and implement them. 

The post A Four-Part Roadmap for Responsible Prior Authorization appeared first on MedCity News.

The law that created ASTP as a formal federal agency gave it duties such as supporting a more effective marketplace and greater competition. Stephen Konya, ASTP’s chief, innovation and strategic partnerships, explained how the agency carries out its mission.

The post How a Tiny Federal Agency Supports Innovation & Competitiveness in the Scientific Community appeared first on MedCity News.

As the safety-net landscape shifts and funding uncertainty grows, the path forward is clear. By investing in highly coordinated, data-informed care and aligning health plans, providers and communities around shared goals, we can build a system that reaches individuals with complex care needs, supports whole-person health initiatives and strengthens care across the board.

The post Connected Care, Shared Goals: Designing Whole-Person Care for Complex Patient Populations appeared first on MedCity News.

Sprinter Health’s $55 million Series B round was led by General Catalyst and included participation from Andreessen Horowitz (a16z) Bio + Health, the Regents of the University of California, Google Ventures and Accel.

The post Sprinter Health Raises $55M to Expand Home Health Services for Health Plans appeared first on MedCity News.

Perhaps the most significant health policy of our time, it revolutionized coverage and access, as well as the way healthcare companies communicated. With its future uncertain, now is the time to look back on how it shaped a new era of healthcare marketing strategy and messaging.

The post The Affordable Care Act’s Lasting Impact On Healthcare Marketing appeared first on MedCity News.

Robert F. Kennedy Jr. testified before the House Committee on Appropriations and the Senate Health, Education, Labor and Pensions Committee on Wednesday. He faced questions on vaccines, HHS cuts and other issues.

The post Congress Scrutinizes RFK Jr. on Budget Cuts, Vaccines and More appeared first on MedCity News.

Cohere Health raked in $90 million in Series C capital, taking its total funding to date to $200 million. This round of funding cements Cohere as the emerging winner in the prior authorization tech category, according to Michael Greeley, general partner at Flare Capital Partners.

The post Cohere Health Snags $90M to Automate the Much-Maligned Prior Authorization Process appeared first on MedCity News.

UnitedHealth Group announced that Andrew Witty will step down as CEO due to “personal reasons.” He is being replaced by Stephen J. Hemsley, who served as the company’s CEO from 2006 to 2017.

The post How Social Media Is Reacting to UnitedHealth Group’s CEO Exit and Stock Meltdown appeared first on MedCity News.

President Trump’s executive order provides a framework for tying the prices of U.S. pharmaceutical products to the lower prices paid in other countries, what’s called most-favored-nation pricing. If drug companies do not lower their prices accordingly, the order proposes other strategies, such as importing drugs from other countries.

The post Trump Strategy to Rein In Drug Prices Revives ‘Most-Favored Nation’ Plan of His First Term appeared first on MedCity News.